HealthTexas Provider Network (HTPN), a large, ambulatory care network in North Texas, is implementing an ambulatory electronic health record (AEHR) to improve the quality, safety, effectiveness, and efficiency of care. The proposed study will evaluate impact of the AEHR implementation on workflow and financial outcome measures, contributing knowledge about the frequently cited perceived barriers to AEHR adoption of uncertainty regarding impact on productivity and financial performance during implementation, and uncertain financial and non-financial costs required to support AEHR implementation and maintenance in primary care settings. This project thus addresses important aspects of decisions to adopt Health Information Technology (IT) to improve health care decision-making through the use of integrated data and knowledge management. HTPN is deploying a commercially available AEHR (GE Centricity Physician Office -EMR 2005), staggered by practice, over ~3.5 years beginning mid-2006. We will use pre- and post-AEHR implementation billing and administrative data to examine impact on workflow and financial outcomes. Aim 1: To estimate the effect of the AEHR on workflow outcome measures. We will examine impact of the AEHR implementation on Non-physician Staff per Physician Full Time Equivalent (FTE), Work Relative Value Units (RVUs) per Physician FTE, Work RVU per Visit, and Visits per Physician FTE;also testing for the possibility the AEHR has differential impacts on these measures over time. Aim 2: To estimate the effect of the AEHR on financial measures. We will examine impact of the AEHR implementation on Practice Expense per Work RVU, Practice Expense per Total RVU, Payment Received per Work RVU, Net Income per Physician FTE, and Net Income per Work RVU;also testing for the possibility the AEHR has differential impacts on these measures over time. Aim 3: To quantify financial and non-financial costs of Health IT implementation and maintenance, contributing knowledge about perceived barriers and facilitators to AEHR adoption and implementation. We will quantify the financial costs of AEHR-related purchases of hardware, software, and system resources;time and effort of the HTPN AEHR Team during deployment at each practice;non-financial costs related to practice physician champions'and office managers'time spent overseeing AEHR implementation tasks (e.g., planning, workflow reengineering, and training);and time spent by physicians, nurses, and office staff preparing for AEHR use (e.g. pre-loading charts, training);and financial and non-financial maintenance costs (e.g., licensing, HTPN corporate personnel, technical support). We will quantify non-financial/opportunity costs by applying salary information from payroll data at the physician, nurse, and office staff levels. This study will inform real world health IT adoption and implementation decisions for stakeholders, especially those along the innovation decision process continuum;and stimulate more comprehensive health IT implementation research by increasing the knowledge-base regarding perceived barriers to health IT implementation in ambulatory care settings.